Health Provider Information
We welcome any other health care providers who may be reading this information. Our purpose for having this page is to first provide information about the current state of affairs in treatment of Idiopathic Scoliosis and second provide information about the SpineCor dynamic corrective scoliosis brace.
Over the years there have been two treatment methods for idiopathic scoliosis, rigid braces and surgical devices. Braces range from the CTLSO type braces like the Milwaukee brace that provides long axis traction and 3-point pressure over the course of the entire spine. There are also the TLSO type braces like the Boston brace and the Providence brace which are not full spine, but work on 3 point pressure in the regions of the spine where most scoliosis are present. The goal of these braces is to stop the progression of the scoliosis, which they have been shown to be effective in doing. The draw backs to these systems though is they do not provide a lot of flexibility, they are hot to wear, they are hard to hide under clothing, they produce atrophy of spinal muscles and ultimately result in the spine returning back to the pre-treatment state and beyond.
The Scoliosis Research Society in 2000 devised a set of guidelines for the use of scoliosis braces. These guidelines were proposed to allow for easy comparison and analysis of scoliosis brace treatment and effectiveness. Everyone involved in the treatment of Idiopathic Scoliosis has to abide by these guidelines. Since the adoption of these guidelines it has become all to clear that the current rigid brace systems fall short on results and in most cases the patients treated with them end up having surgery 60% to 80% of the time. Only one bracing system has been evaluated using the new SRS criteria and been shown to be highly effective at 2 year follow ups, and that brace is the SpineCor dynamic corrective brace.
In fact the results are so promising the University of Michigan has requested that SpineCor be brought in house for further evaluation, and they are excited to research the brace further. This brace is the combined effort of years of investigation by pediatric orthopedic surgeons at the St. Justines Children Hospital in Quebec Canada. The principle developers are Charles Rivard, M.D. and Christine Colliard, M.D. Both have published extensively on the topic of idiopathic scoliosis and have over 20+ years investigating the subject.
Now some may ask, why then is a Chiropractic office involved in something that has historically been a medical treatment. Well the answer is SpineCor has realized that Doctors of Chiropractic (D.C.) are the perfect providers to administer this brace and here is why. First we have the required knowledge of the spine and its kinematics to understand the clinical nature of the brace. D.C.’s also have the required knowledge of X-ray and X-ray line drawing that allows analysis of the spine and classification of the scoliosis, and most D.C.’s have X-ray in house. D.C.’s also have the clinical skill set to perform the prerequisite clinical and postural exams and then correlate them with the X-ray findings to determine the correct classification of scoliosis and then the knowledge and the time to apply the brace and track its effects. Now there are several other providers in the health care arena that can perform parts of the process, but D.C.’s are a one-stop shop for a provider that can do all parts under one roof. Therefore our office has been selected and accredited by SpineCor to provide this brace in the State of Arizona, and we are available to work with any health care professional who wishes to upgrade their treatment of Idiopathic Scoliosis with the SpineCor dynamic corrective brace.
Scoliosis Research Society Inclusion Criteria
- Age at bracing is 10 years and older or more at maturity
- Primary Curve is 25-40 degrees
- Risser sign 0,1 or 2
- No prior treatment
- Females – Premenarchal or one year postmenarchal
- Include all patients regardless of compliance (intent to treat)
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Scoliosis Research Society Assessment Criteria
- Percentage of curves that progressed 5 degrees or less; 6 degrees
- Percentage of patients who progressed beyond 45 degrees
- Percentage of patients that had surgery or recommended for surgery
- Minimum of 2 years follow-up after maturity for successful patient
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Results of Comparison Studies between TLSO braces, Providence brace and the Spinecor brace, all having used the new SRS criteria
| Results 25 to 40 degrees |
|
TLSO* |
PROVIDENCE* |
SPINECOR^ |
| Population |
48
At 2 years follow-up |
35
At 2 years follow-up |
47
At 2 years follow-up |
170
At weaning point |
| < 5 deg. Progression |
7 (15%) |
11 (31%) |
45 (96%) |
101 (59%) |
| Progression > 6 deg. |
41 (85%) |
24 (69%) |
2 (4% |
69 (41%) |
| Progression > 45 deg. |
27 (56%) |
15 (45%) |
4 (9%) |
2 (1%) |
| Surgery |
38 (79%) |
21 (60%) |
1 (2%) |
39 (23%) |
| *Janicki JA, Poe-Kochert C, Armstrong DG, Thompson GH. A comparison of the Thoracolumbosacral Orthoses and Providence Orthorsis in the Treatment of Adolescent Idiopathic Scoliosis: Results Using the new SRS Inclusion and Assessment Criteria for Bracing Studies. J. Pediatric Orthop. 2007 June; 27(4):369-374.^Coillard C, Vachon V, Circo AB, Beausejour M, Rivard CH. Effectiveness of the SpineCor brace Based on the New Standardized Criteria Proposed by the Scoliosis Research Society for Adolescent Idiopathic Scoliosis. J Pediatric Orthop. 2007 June;27(4): 375-379. |
Conclusion:
- New SRS criteria are more restrictive.
- TLSO is minimally effective in the treatment of AIS.
- Providence orthosis appears to be effective but primarily for small curves.
- SpineCor is effective for the treatment of AIS. Moreover, positive outcomes are maintained after 2 years post-bracing.
